South African youth’s understanding of feelings, thoughts, and behaviours: Implications for the development of CBT-based mental health interventions

Suzanne Human, Hermine Gericke, Maria Loades, Paul Stallard, Bronwyne Coetzee

Research output: Contribution to journalArticlepeer-review

1 Citation (SciVal)



Mental health problems are common in youth in low- and middle-income countries (LMICs), including South Africa. Preventative interventions, based on cognitive behaviour therapy (CBT), delivered in schools, have been found to alleviate symptoms of depression and anxiety in high income countries (HICs). However, less is known about whether youth in LMICs are able to engage with the core concepts of CBT.

To explore how young people in the Western Cape, South Africa, understand key CBT concepts, such as feelings, thoughts and behaviours.

We interviewed 22 young people (10–15 years of age; mean age 11.6 years; SD = 1.0) recruited from two public primary schools in the Western Cape, South Africa. Interviews were audio-recorded, transcribed verbatim, translated from Afrikaans into English where necessary and analysed thematically using a deductive approach.

Young people described feelings as internal, private, and should only be shared with trusted others. They also described how feelings varied, depending on the situation. They found the concept of thoughts more challenging to describe. Youth were able to say what they do when they experience unpleasant feelings, and they linked their behaviours to their feelings and thoughts.

In this cultural context, our qualitative investigation found evidence that young people were able to engage with abstract concepts including feelings and to some degree, thoughts. To ensure that CBT-based interventions are developmentally appropriate and accessible, psychoeducation may help youth distinguish between thoughts, feelings and behaviours, and a focus on identifying and naming feelings may be beneficial.
Original languageEnglish
Pages (from-to)447-461
Number of pages15
JournalBehavioural and Cognitive Psychotherapy
Issue number5
Early online date7 Apr 2022
Publication statusPublished - 30 Sept 2022

Bibliographical note

Funding Information:
This research was funded in whole by the Wellcome Trust (213987/Z/18/Z). For the purpose of Open Access, the author has applied a Creative Commons Attribution (CC-BY) public copyright licence to any Author Accepted Manuscript version arising from this submission. Dr Maria Loades is funded by the National Institute for Health Research (NIHR Doctoral Research Fellowship, DRF-2016-09-021). This is independent research. The views expressed in this publication are those of the authors(s) and not necessarily those of the NHS, NIHR or the Department of Health and Social Care.


  • Keywords:
  • adolescents
  • cognitive behaviour therapy
  • low- and middle-income countries
  • mental health
  • psychoeducation
  • sub-Saharan Africa

ASJC Scopus subject areas

  • Clinical Psychology


Dive into the research topics of 'South African youth’s understanding of feelings, thoughts, and behaviours: Implications for the development of CBT-based mental health interventions'. Together they form a unique fingerprint.

Cite this